20050506.pdfz DATE RECEIVED i
7 �l j PERMIT EXPIRES
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION J
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OWNER NAMEINAME OF BUSINESS / Yl
`� / ISUBDIVISION NO, LOT NO LID NO.
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MAILINGADDRESS LID FEE 5
�rC r w p`r/ HT OF WAY PER OFFICIAL STREET MAP TESCP Approved
V % RW Permit Requ,rod
Street Use Permit Required. I7
CITY 21P TELEPHONE PROPOSED Inspection Required OSidewalk Required 0� �� Za c � D �.Z DEDICATION FT __ Wndnr91buuiedNAME IZE LINE SIZE NO. OF FIXTURESPRV REQUIRED
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wADDRESS wNTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE _
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DATE
A�DDDRES�SpE ACCEPTED
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CITY ZIP TELEPHONE c
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OELINE OR ADBY INSPECTION SEPA
STATE LICEN�GN MBER Er ) VARIANCE OR CU
O REQ'D COMPLETED EXEMPT
I 113YES ONO
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. _ _ a " 0c) STUDY13
R ALLOWED PROPOSED ALLOWED PROPOSED
77 0313 - 00q�
❑ NEW ® RESIDENTIAL PLUMTN I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
❑ COMMERCIAL COMPLIANCE OR
❑ ADDITION ❑
MIXED USE CHANGE OF USE
❑
❑
REMODEL 1:1PARKING LOT AREA PLANNING REVIEWED BY DATE MULTIFAMILY ❑ SIGN REQ'D PROVIDED
1:1 REPAIR 1:1 GRADING ❑ FENCE X FT.) REMARKS
CYDS
OTHER
❑ DEMOLISH ❑ TANK ❑
GARAGE ❑ CARPORT 1:1RO ROCKERY1:1
NING WALL 1:1FIRE ALARM FIRE LER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXP IN:
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:MNS R C N C E OCCUPANT
L(
GROUP
i NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
STORIES ` UNITS LOAD
22
REQUIRED 13YES
DESCRIBE WORK TO BE DONE / / /z
REMARKS!. I [
GEOTECH PEOPORT
r / 1 ]-i BY:
avipJ c e (.v e ✓ t' i e / eK t ✓P /vle2 STRUCTURAL DESI N
BY:
VALUATION
S $
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE j
Building Permit City Surcharge r
PLAN CHECK NO: Plumbing Base Fee n
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
E OONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION,
YEngr. Review
L PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
L PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Erlgr. Inspection
BACK OF PINK PERMIT FOR MORE INFORMATION
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk, Deposit
IN INTEREST; AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE .--
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE .PROVISION i
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a parrnil until signed by the
THE OWNER, 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or ackno/herwledged
edged in and Fees are paid, and
IN VIOLATION OF THE LAB CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided__
WORKMEN'S COMPENSAT URANCE AND RCW 18:27,
OFFICIA S 51 NATURE DTE
SIGNATUF 9IER O EN DATE SI NED (425)
iij
771 -0220 RELEASED B DATE
ATT TION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW • INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110, PINK -OWNER • GOLD - ASSESSOR
10104 PRESS HARD- YOU ARE MAKING 4 COPIES
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